Preliminary Evidence to Support the use of Startle Adjuvant Rehabilitation Therapy (START) via tele-health sessions to promote accessibility and reduce socioeconomic disparities in post-stroke care

Research Objectives Investment in the development of novel tools that make therapy more accessible to individuals with low socioeconomic status who are more likely to have a stroke and to have severe upper extremity dysfunction post-stroke are needed. Startle Adjuvant Rehabilitation Therapy (START), a tele-enabled, low-cost treatment to improve therapy outcomes for stroke survivors is the application of a startling, acoustic stimulus (via headphones) administered in conjunction with traditional therapy. The purpose of this study was to determine if START can be used to enhance movement of the upper extremity. Design Stratified, parallel-group, double-blind, randomized controlled trial. Setting Outcomes assessed in a university laboratory. START intervention received at home. Participants Projected enrollment of 25 adults, >6 months post-stroke with evidence of severe upper extremity spasticity, and 25 healthy controls. Individuals were excluded for uncontrolled medical conditions, or other unrelated neurological or cognitive deficits. Interventions Three consecutive days of training focusing on object manipulation for 1 hour per session via Zoom. A cellphone and headphones were used to administer the acoustic startle. Main Outcome Measures Baseline, one day post-intervention, and one-month post-intervention: Modified Ashworth Scale (MAS) for spasticity, Upper Extremity Fugl-Meyer Motor Assessment (UEFM) and the Action Research Arm Test (ARAT) for arm impairment and activity, Motor Activity Log (MAL) and Stroke Impact Scale (SIS) (hand and participation sections) for self-report measures of arm and hand use. Results Data collected thus far has demonstrated a 17.4% increase in UEFM in the START group (Control decreased in UEFM -8%). The START group also self-reported more arm usage (Motor Activity Log, 78%) compared to Control (-6%). The SIS for the hand increased in the START group (39%) compared to the Control group (-44%). No significant difference was found in function using the ARAT (START: 7%; Control 8%). Conclusions A 3-day treatment of START impacts impairment (UEFM) and self-reported arm function (MAL) but does not lead to functional improvements. Future studies should include longer duration and consider training that facilitates functional gains. Author(s) Disclosures None.